An accurate and complete removal of a tumor, with minimal collateral damage to the surrounding tissue, can be guided by the examination of pathology. However, the pathology prepared, either during surgery or after, can be time consuming. In the setting of Mohs surgery of non-melanoma skin cancers, frozen pathology that can be prepared during the procedure can take 20-45 minutes per excision, and two or more excisions can be performed, which can make the total preparation time several hours (See e.g., Reference 1). In other settings, such as head-and-neck and breast cancer, surgery fixed pathology can be prepared following the surgery. Preparation of fixed sections can take at least 1-2 days. Such time delays can result in an inability to sample large amounts of tissue, and detection of residual tumor margins, in real time. Consequently, insufficient sampling of tissue, incomplete tumor removal and positive margins are reported to be between 20 to 70% of patients (See e.g., References 2 and 3). A large number of such patients subsequently undergo additional surgery, radiotherapy and/or chemotherapy. The optical imaging methods that can display nuclear morphology can offer real-time detection of tumors in large areas of freshly excised or biopsied tissue without the need for the processing that can be used in pathology. One well-known approach is based on confocal microscopy (See e.g., References 4 and 7) and another, more recent approach, is based on full-field optical coherence tomography (See e.g., Reference 8).
It can be possible to utilize confocal mosaicing microscopy procedures for imaging tumor margins in fresh tissue from surgery (See e.g., References 9 and 12). In one such exemplary embodiment, it can be possible to provide access to high-resolution images of large areas of tissue within a short time period (e.g., a few minutes).
For example, square confocal images can be collected and stitched together with custom software into a mosaic that displays a large field of view. The mosaicing of about 36×36 images (e.g., to display up to 12×12 mm2 of excised tissue from Mohs surgery) can be provided in a short time frame, for example, in about 9 minutes (See e.g., References 4, 9, and 10). In a blind examination of 45 fluorescence mosaics by two Mohs surgeons, basal cell carcinoma margins were detected with an overall sensitivity of 96.6%, and a specificity of 89.2% (See e.g., References 13 and 14).
Indeed, obtaining the results in such time frame can certainly be faster than the hours or days generally required for preparing pathology; however, routine implementation in Mohs surgical settings can benefit from even faster times. In other surgical settings, excisions can be larger, and thus mosaicing by such exemplary procedure can take longer. Therefore, the adaptation of such technology to be used during surgery may not be as effective. For practical and routine utility, the exemplary mosaicing should meet the surgeons' need to examine tumor margins in large areas (e.g., ˜cm2) within fairly short times (e.g., ˜one minute).
Thus, it may be beneficial to provide exemplary systems, methods and computer-accessible mediums that can facilitate a shorter imaging time, and/or solve at least some of the deficiencies described herein above.